RESUMO
Brucella melitensis is the main cause of human brucellosis worldwide and is considered the most virulent and neurotropic species. In Mexico, this species is considered endemic, being reported since the first decade of the 20th century. Here we present a case of subacute transverse myelitis with the isolation and identification of B. melitensis as the causative agent of Neurobrucellosis in a female patient from the coastal state of Guerrero, Mexico.
Assuntos
Brucella melitensis/isolamento & purificação , Brucelose/diagnóstico , Mielite Transversa/diagnóstico , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Brucelose/complicações , Brucelose/tratamento farmacológico , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Infusões Intravenosas , Mielite Transversa/complicações , Mielite Transversa/tratamento farmacológicoRESUMO
SARS-COV-2 infection has affected millions of individuals with a wide range of clinical manifestations, including central and peripheral nervous systems through several mechanisms. A rare but potentially severe manifestation of this virus is transverse myelitis. Herein, we report on two patients who developed paraparesis, sensory deficit, and autonomic changes on the tenth day after infection by COVID-19. A 27-year-old man, previously healthy, had symptoms of COVID-19 confirmed by oropharyngeal and nasopharyngeal swab tests. On the tenth day of symptoms, the patient started to experience acute paraparesis, urinary retention, constipation, and hypoesthesia up to the T4 level. The second patient is a 50-year-old man, previously healthy, who had symptoms of the flu-like syndrome. The diagnosis of COVID-19 infection was confirmed by oropharyngeal and nasopharyngeal swab tests. On the tenth day of symptoms, the patient started to experience paraparesis, urinary incontinence, and hypoesthesia up to the T6 level. The neuroimaging and cerebrospinal fluid (CSF) analysis of both patients confirmed acute transverse myelitis after COVID-19 infection. High-dose corticosteroid therapy was started, and both patients showed rapid recovery from their deficits. Although rare, post-infectious transverse myelitis may be related to SARS-COV-2 infection and should be quickly recognized. Although controlled studies are needed, treatment with corticosteroid therapy in high doses was effective in these patients.
Assuntos
Corticosteroides/uso terapêutico , COVID-19/complicações , Mielite Transversa/tratamento farmacológico , Mielite Transversa/virologia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
We report a case of transverse myelitis in an immunocompetent host with an atypical long onset of symptoms. A 56-year-old man was admitted to the hospital reporting 5 months of progressive ascending lower extremity weakness and numbness, inability to walk, bowel incontinence,urinary retention and several episodes of nausea and vomiting. MRI showed moderate spinal swelling and multiple hyperintense signal changes on cervical levels C2-C5 and thoracic levels T1-T3. Cerebrospinal fluid (CSF) showed pleocytosis and was positive for anti-cytomegalovirus (CMV) IgG intrathecal antibodies, but the CSF PCR for CMV was negative. The diagnosis of immune-mediated CMV-related transverse myelitis was established and the patient was treated with methylprednisolone and valgancyclovir. The patient had poor recovery and remained paraplegic at discharge.
Assuntos
Anti-Inflamatórios/uso terapêutico , Infecções por Citomegalovirus/fisiopatologia , Citomegalovirus/isolamento & purificação , Ganciclovir/análogos & derivados , Metilprednisolona/uso terapêutico , Mielite Transversa/fisiopatologia , Paraplegia/virologia , Medula Espinal/fisiopatologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Progressão da Doença , Evolução Fatal , Ganciclovir/uso terapêutico , Humanos , Imunocompetência , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite Transversa/tratamento farmacológico , Mielite Transversa/virologia , Paraplegia/fisiopatologia , Medula Espinal/virologia , ValganciclovirRESUMO
Clinical, neuroimaging, and laboratory features are not specific enough to establish the etiological diagnosis of the acute inflammatory myelitis (AIM). Longitudinally extensive transverse myelitis (LETM) seen on magnetic resonance imaging (MRI) has been associated with a poor functional prognosis. The aim of this study was to assess the functional outcomes of a first AIM event comparing patients with LETM vs. no LETM on MRI and to report the differential diagnosis. Clinical, radiological, biochemical aspects were collected, and Winner-Hughes Functional Disability Scale (WHFDS) was performed after 3 and 6 months. Centromedullary lesions were associated with LETM, lateral lesions with partial lesion (PL), and brain MRI lesions with multiple sclerosis and acute encephalomyelitis disseminated. LETM patients were associated with a worse functional outcome as the need of a wheelchair after 3 and 6 months (OR = 7.61 p = 0.01; OR 4.8 p = 0.04, respectively), a walker or cane (OR = 11.0 p = 0.002, OR = 4.3 p = 0.03, respectively). In addition, we found a correlation between LETM and acute complete transverse myelitis and PL with acute partial transverse myelitis (83.3 and 90.9%, respectively; p < 0.0001). In conclusion, AIM is a heterogeneous syndrome from an etiological point of view and LETM patients had worse functional prognosis compared with PL after 3 and 6 months.
Assuntos
Imageamento por Ressonância Magnética/tendências , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/etiologia , Recuperação de Função Fisiológica/fisiologia , Adulto , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Encefalomielite/complicações , Encefalomielite/diagnóstico por imagem , Feminino , Humanos , Masculino , Metilprednisolona/farmacologia , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico por imagem , Mielite Transversa/tratamento farmacológico , Neuromielite Óptica/complicações , Neuromielite Óptica/diagnóstico por imagem , Recuperação de Função Fisiológica/efeitos dos fármacos , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Objective The purpose of this study was to describe the clinical characteristics of acute transverse myelitis, including the time of their presentation, and to evaluate their effect on accrual damage in patients with systemic lupus erythematosus (SLE). Methods Patients with SLE who were hospitalized because of incident, noninfectious myelitis at our institute between January 1997 and December 2013 were identified. As a control group, we selected for each of the patients in the study group one SLE patient hospitalized at the closest date to the case due to other severe non-neuropsychiatric (NP) SLE manifestation, with no history of NP manifestations or noninfectious disease. Clinical characteristics, laboratory results, treatment, disease activity (SLEDAI-2K), and damage (SLICC/ACR-DI) were collected from medical charts at the index hospitalization and one year after hospitalization. Results Demographics and SLE characteristics, including age at SLE diagnosis and time since SLE diagnosis to hospitalization, were comparable in patients with myelitis and controls. At hospitalization, disease activity and cumulative damage were similar in both groups. Patients with myelitis received more aggressive treatment than controls. One year after hospitalization, two of the 15 patients who completed follow-up had symptom improvement without neurologic sequelae, and 13 of them had some improvement of symptoms with neurologic sequelae. Four patients died in the myelitis group, three of them of infectious diseases, and one of alveolar hemorrhage. No patient died because of myelopathy and in the control group no patient died, although three were lost during the follow-up. Disease activity and treatment did not differ between both groups. However, cumulative damage was higher among the patients with myelitis than controls (1.9 ± 0.9 vs 0.75 ± 0.9; p = 0.003). Conclusion Patients with myelitis have clinical characteristics similar to those observed in non-NP SLE and receive more aggressive treatment. Furthermore, myelitis is associated with a significant increase in accrual damage compared with severe non-NP manifestations.
Assuntos
Encéfalo/diagnóstico por imagem , Vasculite Associada ao Lúpus do Sistema Nervoso Central/complicações , Vasculite Associada ao Lúpus do Sistema Nervoso Central/tratamento farmacológico , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/tratamento farmacológico , Adulto , Líquido Cefalorraquidiano/virologia , Ciclofosfamida/uso terapêutico , Feminino , Hospitalização , Humanos , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , México , Fármacos Neuroprotetores/uso terapêutico , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
La mielitis transversa longitudinal extensa (MTLE) se define como lesión de la médula espinal con una extensión de tres o más cuerpos vertebrales. La presentación clínica dependerá del área anatómica afectada incluyendo paraparesia, paraplejia, parestesias o pérdida sensorial en diferentes modalidades, síntomas urinarios entre otros. Sus etiologías son diversas como ser procesos metabólicos, tóxicos, inflamatorios, infecciosos. En el presente artículo describimos tres interesantes casos clínicos de MTLE. El primero una paciente joven con neuromielitis óptica; el segundo una paciente con neurosarcoidosis y el último caso un paciente con mielopatía tóxica producida por abuso de óxido de nitrógeno. Todos ellos con presentación clínica y radiológica similar resaltando la importancia de la obtención de una buena historia clínica.
Longitudinal extensive transverse myelitis (LETM) is defined as a spinal cord lesion that compromise 3 or more vertebral segments. Clinical presentation varies and will depend on the anatomical area that is compromised including paraparesis, paraplegia, paresthesia or sensory loss of any modalities and urinary or bowel symptoms. The etiologies are several such as toxic - metabolic abnormalities, inflammatory or infectious. Here in we present three interesting cases of LETM; the first case is a young patient with neuromyelitis optica; the second a case of neurosarcoidosis and the last case a toxic myelopathy secondary to nitrous oxide abuse. All of them with similarities in their clinical and radiologic presentation but with different etiologies highlighting the importance of obtaining a good medical history.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Mielite Transversa/tratamento farmacológico , Doenças da Medula Espinal/patologia , Mielite Transversa/diagnósticoRESUMO
Transverse myelitis (TM) is an inflammatory process involving restricted areas of the spinal cord. The usually dramatic presentation with rapidly progressive symptoms involving motor, sensory and autonomic functions makes acute TM a medical emergency. Acute TM has been cited as a rare and unusual complication of systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS), but early diagnosis and aggressive treatment might improve the prognosis. This review of the literature (MEDLINE), showed that, within autoimmune diseases, acute transverse myelitis is mainly associated with SLE and SS. Previous studies seem to indicate that the presence of antiphospholipid antibodies might play a role in the etiology of TM. Although no uniform therapeutic protocol exists, and the prognosis is usually poor, early aggressive treatment (usually with EV pulses of methylprednisolone and cyclophosphamide) might improve the prognosis.
Assuntos
Doenças Autoimunes do Sistema Nervoso/complicações , Mielite Transversa/etiologia , Adolescente , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , Síndrome Antifosfolipídica/complicações , Criança , Terapia Combinada , Diagnóstico Precoce , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Doença Mista do Tecido Conjuntivo/complicações , Mielite Transversa/diagnóstico , Mielite Transversa/tratamento farmacológico , Mielite Transversa/epidemiologia , Mielite Transversa/terapia , Plasmaferese , Síndrome de Sjogren/complicações , Resultado do Tratamento , Adulto JovemRESUMO
Transverse myelitis is a group of disorders characterized by focal inflammation of the spinal cord and results in loss of motor and sensory function below the level of injury. Occurrence of this condition during or following varicella infection is uncommon. This report describes two cases of transverse myelitis caused by varicella zoster.
Assuntos
Varicela/complicações , Herpesvirus Humano 3 , Mielite Transversa/virologia , Doença Aguda , Aminas/uso terapêutico , Amitriptilina/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Feminino , Gabapentina , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Mielite Transversa/tratamento farmacológico , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
Transverse myelitis is a group of disorders characterized by focal inflammation of the spinal cord and results in loss of motor and sensory function below the level of injury. Occurrence of this condition during or following varicella infection is uncommon. This report describes two cases of transverse myelitis caused by varicella zoster.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Varicela/complicações , Mielite Transversa/virologia , Doença Aguda , Aminas/uso terapêutico , Amitriptilina/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Glucocorticoides/uso terapêutico , Metilprednisolona/uso terapêutico , Mielite Transversa/tratamento farmacológico , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
In the setting of HIV infection, cytomegalovirus (CMV) and herpes simplex virus type 1-2 (HSV 1-2) can affect both the central and peripheral nervous systems. These agents can involve the spinal cord and produce a necrotizing transverse myelitis. This usually occurs in AIDS patients with severe immunodeficiency: CD4+ lymphocyte counts typically are less than 50 cell/microL. The clinical presentation, CSF and imaging studies can provide a high level of suspicion diagnosis. Prompt initiation of antiviral specific drugs is essential. We report a patient with an acute necrotizing myelitis (cauda equina syndrome) secondary to CMV and HSV infections.